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2. Applicant Information
4. Last Name
5. First Name
6. Middle Initial
7. Date
   Date
9. Street Address
10. Apartment / Unit Number
12. City
13. State
14. Zip Code
16. Phone
17. Email
19. Date Available
    Date Available
20. Desired Salary
22. Position Applied for
24. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

    Proof of citizenship or immigration status will be required upon employment.

    1. Yes
    2. No
26. Have you ever worked for the Borough?

    1. Yes
    2. No
27. If so, when?
29. Have you previously filed an application here?

    1. Yes
    2. No
30. If so, when?
32. Are you currently on "lay-off" status and subject to recall?

    1. Yes
    2. No
34. Are you available to work:

    1. Full-time
    2. Part-time
    3. Temporary
35. Dates available
    Dates available Start Date

    —

    Dates available End Date
37. Do any of your friends or relatives, other than spouse, work here?

    1. Yes
    2. No
41. Education
43. High School
44. Address
46. Years Completed
47. Did you graduate?

    1. Yes
    2. No
48. Degree
50. College
51. Address
53. Years Completed
54. Did you graduate?

    1. Yes
    2. No
55. Degree
57. Other (Specify)
58. Address
60. Years Completed
61. Did you graduate?

    1. Yes
    2. No
62. Degree
66. References
    Please list three professional references.
68. Full Name
69. Relationship
71. Company
72. Phone
74. Address
76. Full Name
77. Relationship
79. Company
80. Phone
82. Address
84. Full Name
85. Relationship
87. Company
88. Phone
90. Address
94. Previous Employment (Begin with the Most Recent)
96. Company
97. Phone
99. Address
100. Supervisor
102. Job Title
104. Responsibilities
106. Employed From / To
     Employed From / To Start Date

     —

     Employed From / To End Date
107. Reason for Leaving
109. Are you currently employed?

     1. Yes
     2. No
110. May we contact your previous supervisor for a reference?

     1. Yes
     2. No
112. Company
113. Phone
115. Address
116. Supervisor
118. Job Title
120. Responsibilities
122. Employed From / To
     Employed From / To Start Date

     —

     Employed From / To End Date
123. Reason for Leaving
125. Are you currently employed?

     1. Yes
     2. No
126. May we contact your previous supervisor for a reference?

     1. Yes
     2. No
128. Company
129. Phone
131. Address
132. Supervisor
134. Job Title
136. Responsibilities
138. Employed From / To
     Employed From / To Start Date

     —

     Employed From / To End Date
139. Reason for Leaving
141. Are you currently employed?

     1. Yes
     2. No
142. May we contact your previous supervisor for a reference?

     1. Yes
     2. No
146. Military Service
148. Branch
149. From / To
     From / To Start Date

     —

     From / To End Date
151. Rank at Discharge
152. Type of Discharge
154. If other than honorable, explain.
156. Specialized Skills
     State any special skills, experience, training, licenses, certifications, foreign language proficiency or other factors that make you especially qualified for the position for which you are applying.
160. Applicant's Statement
162. Understandings and Agreements
     As an applicant for a position with the Borough of Hawthorne, I understand and agree that I must provide truthful and accurate information in this application. I understand that my application may be rejected if any information is not complete, true and accurate. If hired, I understand that I may be separated from employment if the Borough of Hawthorne later discovers that information on this form was incomplete, untrue, or inaccurate.
     I give the Borough of Hawthorne the right to investigate the information I have provided, talk with former employers (except where I have indicated they may not be contacted). I give the Borough of Hawthorne the right to secure additional job-related information about me. I release the Borough of Hawthorne and its representatives from all liability for seeking such information. I understand that the Borough of Hawthorne is an equal-opportunity employer and does not discriminate in its hiring practices.
     I understand that the Borough will make reasonable accommodations as required by the Americans with Disabilities Act. I understand that, if employed, I may resign at any time and that the Borough of Hawthorne may make any assurances to the contrary.
     I understand that any offer of employment may be subject to job-related driver's license abstract check as well as medical, physical, drug, or psychological tests. I also understand that some positions may involve complete background and criminal checks. I understand that in accordance with P.L. 70 2011 Chapter 70, "every person holding an office, employment or position" in the State of New Jersey shall have their "principal residence" in the State of New Jersey." Employees hired after September 1, 2011 shall establish residency within one year or shall be deemed unqualified for holding the office, employment or position.
164. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
166. Electronic Signature
167. Date
     Date
Leave This Blank:


172. 1. Receive an email copy of this form.
173. Email address

     This field is not part of the form submission.

174. Submit

* indicates a required field